2016-08-04T10:51:24-05:00 2015-09-30 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2014-10-01 470468078 JEFFERSON COMMUNITY HEALTH CENTER INC JEFF 4027293351 2200 H STREET PO BOX 277 FAIRBURY NE 68352 CHANCE KLASEK CFO 4027293351 2016-08-03 1 BARBARA J FAJEN P00400874 4023302660 2014 2016-12-15 16:53:06Z CHANCE KLASEK 2200 H STREET PO BOX 277 FAIRBURY NE 68352 18411560 0 X HTTP://JCHC.US X 1960 NE JCHC WILL PROVIDE AN EXCEPTIONAL HEALTHCARE EXPERIENCE FOR EVERY PATIENT, EVERY TIME. 9 4 253 15 0 0 122707 96143 16849719 17848635 80652 127021 112227 127100 17165305 18198899 0 0 0 0 8435125 8498185 0 0 12181 7927061 9023229 16362186 17521414 803119 677485 24138736 24742383 7298657 7306442 16840079 17435941 JCHC WILL PROVIDE AN EXCEPTIONAL HEALTHCARE EXPERIENCE FOR EVERY PATIENT, EVERY TIME. 0 0 14332277 15376307 JEFFERSON COMMUNITY HEALTH CENTER OPERATES A 17 BED ACUTE CARE HOSPITAL. JEFFERSON COMMUNITY HEALTH CENTER ALSO OPERATES A WELLNESS CENTER AND PROVIDES HOME HEALTH SERVICES. 1450718 2472328 JEFFERSON COMMUNITY HEALTH CENTER OPERATES A 40 BED LONG-TERM CARE FACILITY FOR THE RESIDENTS OF JEFFERSON COUNTY AND THE SURROUNDING AREA. 15782995 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 8 0 1 253 1 0 0 0 0 0 0 0 0 0 0 X 9 4 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 X CHANCE KLASEK 4027296856 2200 H STREET PO BOX 277 FAIRBURY NE 68352 DICK HOPPE CHAIRMAN 1.00 0.00 X X 0 0 0 BRIAN SCHEELE VICE CHAIRMAN 1.00 0.00 X X 0 0 0 LYMON HAMM SECRETARY/TREASURER 1.00 0.00 X X 0 0 0 LINDA BAUER MEMBER 1.00 0.00 X 0 0 0 BRIAN BLOBAUM MEMBER 1.00 0.00 X 0 0 0 MARY GLENN MEMBER 1.00 0.00 X 0 0 0 CARMEN HINMAN MEMBER (01/01/15 - PRESENT) 1.00 0.00 X 0 0 0 MIKE STEELE MEMBER 1.00 0.00 X 0 0 0 DR TED TUCKER MEMBER 1.00 0.00 X 0 0 0 JACK WESCH MEMBER (10/01/14 - 12/31/14) 1.00 0.00 X 0 0 0 CHAD JURGENS CEO 40.00 0.00 X 152165 0 22020 CHANCE KLASEK CFO 40.00 0.00 X 98046 0 14776 GARY MITCHELL DIRECTOR OF PHARMACY 40.00 0.00 X 138426 0 21458 DENNIS RUSSEL PHARMACIST 40.00 0.00 X 105956 0 19790 MEGAN LARKINS PHARMACIST 40.00 0.00 X 102714 0 19620 597307 0 97664 4 0 1 0 FAIRBURY CLINIC PC 825 22ND STREET FAIRBURY NE 68352 ER COVERAGE 603198 SIEMENS MEDICAL SOLUTIONS 40 LIBERTY VOULEVARD MALVERN PA 19355 XRAY MACHINE 601115 SYSCO 900 KINGBIRD ROAD LINCOLN NE 68521 FOOD SERVICE 364096 SOUTHEAST ANESTHESIA SERVICES 8426 W BIRCH CLATONIA NE 68328 CRNA SERVICES 360000 MEDHOST OF TENNESSEE 6550 CAROTHERS PARKWAY 100 FRANKLIN TN 37067 HEALTHCARE INFORMATION TECHNOLOGY 223407 15 10768 85375 13267 96143 MEDICARE/MEDICAID PAYMENTS 624100 10133122 10133122 PATIENT SERVICE REVENUE 624100 7021711 7021711 CEDARWOOD ASSISTED LIVING SVC FEE 623000 477116 477116 CEDARWOOD: EQUITY IN JT VENTURE 623000 152064 152064 EHR INCENTIVE PAYMENTS 624100 51541 51541 13081 13081 17848635 120743 120743 213992 207714 6278 6278 6278 5259 10768 4947 312 312 CAFETERIA 722210 126788 126788 126788 18198899 17848635 0 254121 X 287006 287006 192738 192738 6576075 6049399 519848 6828 215947 199107 16840 726177 668267 57910 500242 450936 48847 459 3547 3547 45904 45904 19477 19477 2018056 1837004 180771 281 131998 128962 2458 578 1182300 918418 261108 2774 18634 18634 333968 318316 15652 32642 27994 4648 44251 31422 12829 138774 128330 10444 1514917 1400901 114016 81937 81937 MEDICAL SUPPLIES 2519538 2519538 BAD DEBTS EXPENSE 458902 458902 FOOD EXPENSE 393954 393954 DUES AND SUBSCRIPTIONS 72526 32886 39142 498 11904 7287 3854 763 17521414 15782995 1726238 12181 450 450 5265213 5027604 2106663 2527847 347415 372722 95038 152196 24676500 11579893 13082293 13096607 2769345 2737100 272679 424743 199640 403114 24138736 24742383 1912338 1481643 4209501 5610297 265720 201645 911098 12857 7298657 7306442 X 16704973 17297310 84352 87877 50754 50754 16840079 17435941 24138736 24742383 677485 -81623 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1601 1601 0 PART II-B, LINE 1: JCHC PAID DUES TO THE NEBRASKA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THE DUES WERE USED FOR LOBBYING ACTIVITIES. 50754 50754 50754 50754 50754 50754 50754 50754 50754 50754 0.00000 1.00000 0.00000 0 0 13943 13943 19138953 6953268 12185685 5369683 4548335 821348 153921 78290 75631 13096607 ACCRUED INTEREST 12857 12857 X 17643844 -81623 4947 -76676 17720520 19477 458902 478379 18198899 17047982 4947 4947 17043035 19477 458902 478379 17521414 PART V, LINE 4: THE INTENDED USE OF THE HOSPITAL'S ENDOWMENT FUNDS IS TO PROVIDE NURSING SCHOLARSHIPS AND CAPITAL IMPROVEMENTS. PART X, LINE 2: THE HEALTH CENTER IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN THE HEALTH CENTER'S TAX EXEMPT STATUS. IN GENERAL, SUCH STANDARDS REQUIRE THE HEALTH CENTER TO MEET A COMMUNITY BENEFITS STANDARD AND COMPLY WITH VARIOUS LAWS AND REGULATIONS. THE HEALTH CENTER ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE HEALTH CENTER RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT SEPTEMBER 30, 2015, THE HEALTH CENTER HAD NO UNCERTAIN TAX POSITIONS ACCRUED. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 4,947. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 458,902. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 4,947. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 458,902. GOLF TOURNAMENT 16027 10768 5259 1440 1135 1130 810 432 16027 10768 5259 1440 1135 1130 810 432 4947 312 1 1 1 X 1 X 1 1 1 0 1 1 132001 132001 0.00770 1601730 1727510 -125780 0.00000 1733731 1727510 6221 0.00770 13175 13175 0.00080 7250 7250 0.00040 474120 227865 246255 0.01440 14287 14287 0.00080 508832 227865 280967 0.01640 2242563 1955375 287188 0.02410 1 458902 62411 7303210 7373577 -70367 X 1 1 1 1 JEFFERSON COMMUNITY HEALTH CENTER 2200 H STREET FAIRBURY NE 68352 HTTP://JCHC.US 440001 X X X X JEFFERSON COMMUNITY HEALTH CENTER INC 1 0 0 1 X X X X X X X 12 1 0 0 1 X HTTP://JCHC.US X 1 12 1 HTTP://JCHC.US 0 0 1 X 150.000000000000 300.000000000000 X X X X 1 1 X X X 1 X HTTP://JCHC.US X HTTP://JCHC.US X HTTP://JCHC.US X X X X X 1 X 0 X X X X 1 X 0 0 JEFFERSON COMMUNITY HEALTH CENTER, INC. PART V, SECTION B, LINE 5: JEFFERSON COMMUNITY HEALTH CENTER (JCHC) BEGAN ITS HEALTH NEEDS ASSESSMENT IN DECEMBER 2012. JCHC WORKED WITH PUBLIC HEALTH SOLUTIONS DISTRICT HEALTH DEPARTMENT, REVIEWED INTERVIEWS CONDUCTED BY PUBLIC HEALTH SOLUTIONS, CONDUCTED INTERVIEWS WITH LOCAL ORGANIZATIONS, CONDUCTED INTERVIEWS WITH JCHC STAFF AND REVIEWED STATISTICS MADE AVAILABLE THROUGH PUBLIC HEALTH SOLUTIONS AND THE STATE OF NEBRASKA. MEETINGS WERE CONDUCTED WITH LOCAL COMMUNITY ORGANIZATIONS INCLUDING KIWANIS, ROTARY, AGRICULTURE REPRESENTATIVES AND SENIOR DINERS. A TOTAL OF 83 ATTENDED AND PARTICIPATED. IN ADDITION, MEETINGS WERE HELD WITH JEFFERSON COMMUNITY HEALTH CENTER STAFF WHO ALSO REPRESENT THE AREA IN WHICH THEY LIVE. A TOTAL OF 71 JCHC STAFF MEMBERS PARTICIPATED.PUBLIC HEALTH SOLUTIONS DISTRICT HEALTH DEPARTMENT CONDUCTED ITS COMMUNITY HEALTH IMPROVEMENT PLAN STUDY OF A FIVE COUNTY AREA WITH THE ASSISTANCE OF LANE GEWECKE CONSULTING IN NOVEMBER 2012. JEFFERSON COMMUNITY HEALTH CENTER, INC. PART V, SECTION B, LINE 11: PRIORITIZED NEEDS (AS DETERMINED BY COMMUNITY HEALTH NEEDS ASSESSMENT):1) MAJOR DISEASE FACTORS FOR OUR COUNTY- CARDIAC/CEREBROVASCULAR HEALTH, DIABETES, CHRONIC LUNG, CANCER; 2) LIFESTYLE ISSUES- OBESITY, SEDENTARY LIFESTYLE, NUTRITION EDUCATION AND INFORMATION, PERSONAL RESPONSIBILITY/HEALTHY LIFESTYLE; 3) ADDITIONAL SPECIALTY CLINICS NEEDED IN OUR COMMUNITY: DERMATOLOGY, PULMONOLOGY, OBSTETRICS; 4) DENTAL CARE; 5) MENTAL HEALTH1)MAJOR DISEASE FACTORS- CARDIO/CEREBROVASCULAR HEALTH, DIABETES, CHRONIC LUNG, CANCER:IN PRIORITIZING NEEDS, THESE MAJOR DISEASE FACTORS WERE ALL GROUPED TOGETHER BECAUSE ANY PROGRAMS WHICH MAY ASSIST WITH ONE AREA HAS A POTENTIAL IN ASSISTING IN SEVERAL AREAS: A) REVIEW ALL PROGRAMS WHICH ARE CURRENTLY BEING OFFERED IN THE COMMUNITY WHICH CAN HAVE A POSITIVE EFFECT ON THESE MAJOR DISEASE FACTORS (FOR EXAMPLE, BLOOD PROFILE SCREENINGS HELD ANNUALLY AT A REDUCED COST TO HELP AREA RESIDENTS DETERMINE WHAT THEIR MAJOR HEALTH NEEDS ARE, SIMPLYWELL OFFERED TO ALL EMPLOYEES TO RAISE AWARENESS FOR THEIR PERSONAL HEALTH NEEDS, CARDIAC REHABILITATION OFFERED, DIABETES EDUCATION OFFERED AND EXPANDING, CARE TRANSITIONS TEAMS WORKING ON PATIENT EDUCATION AND CONGESTIVE HEART FAILURE AND COPD); B) PROVIDE DATA FOR ALL AREAS SHOWING THE COMMUNITY'S HEALTH NEEDS IN EACH OF THESE AREAS, AND ENCOURAGE THE CONTINUATION AND/OR EXPANSION OF EXISTING PROGRAMS, AND THE DEVELOPMENT OF NEW PROGRAMS TO RAISE AWARENESS AND IMPROVE THE HEALTH AND WELLNESS OF INDIVIDUALS IN THESE AREAS; C) PARTNER WITH PROGRAMS SUCH AS PUBLIC HEALTH SOLUTIONS, QUALITY ORGANIZATIONS; D) REVIEW NEW DATA AS IT BECOMES AVAILABLE ON OUR EFFECTIVENESS AT PROVIDING CARE TO VARIOUS DISEASE FACTORS, AS WELL AS OUR IMPACT ON REDUCING THESE DISEASE FACTORS; E) UTILIZE LIFESTYLE IMPROVEMENT PROGRAMS TO AFFECT THE HEALTH OF OUR PATIENTS WITH THESE CHRONIC DISEASES, AND TO PREVENT THESE CHRONIC DISEASES FROM DEVELOPING.2)LIFESTYLE ISSUES- OBESITY, SEDENTARY LIFESTYLE, NUTRITION EDUCATION AND INFORMATION, PERSONAL RESPONSIBILITY/HEALTHY LIFESTYLE: A) CONTINUE TO DETERMINE WAYS JCHC CAN BENEFIT THE COMMUNITY'S LIFESTYLE ISSUES THROUGH ITS SERVICES AND PROGRAMS (BOB AND WAUNETA BURKLEY WELLNESS CENTER, DIETITIAN SERVICES, WALKING AND WEIGHT LOSS PROGRAMS SUCH AS LIVEWELL SERIES, AND SIMPLYWELL PROGRAMMING FOR STAFF); B) PURSUE PARTNERSHIPS WITH PUBLIC HEALTH SOLUTIONS, AREA PUBLIC SCHOOLS, BLUE VALLEY COMMUNITY ACTION AND OTHER AREA SERVICE AGENCIES AND BUSINESSES TO REACH AREA RESIDENTS; C) PROVIDE COMMUNITY EDUCATION THROUGH ANNUAL SAFETY FAIR, JEFFERSON COUNTY EXPO (INCLUDING HEALTH FAIR OFFERINGS), AND JEFFERSON COUNTY FAIR. 3) ADDITIONAL SPECIALTY CLINICS NEEDED IN OUR COMMUNITY- DERMATOLOGY, PULMONOLOGY, OBSTETRICS:A) DETERMINE NUMBER OF PEOPLE WHO MIGHT BENEFIT FROM ADDITIONAL SPECIALTY CLINICS; B) WORK WITH LOCAL PHYSICIANS TO DETERMINE THEIR PERCEPTION OF NEED FOR ADDITIONAL SPECIALTY CLINICS; C) IF NEED IS VERIFIED, WORK WITH LOCAL PHYSICIANS AND SPECIALISTS TO IMPLEMENT NEW SPECIALTY CLINICS. 4) DENTAL CARE:A) COLLABORATE WITH PUBLIC HEALTH SOLUTIONS IN PROGRAMS IT IS WORKING ON REGARDING DENTAL CARE AVAILABILITY IN JEFFERSON COUNTY. 5) MENTAL HEALTH:A) DETERMINE HOW JEFFERSON COMMUNITY HEALTH CENTER MIGHT BE ABLE TO MEET THE COMMUNITY'S MENTAL HEALTH NEEDS; I) OBTAIN INFORMATION FROM OTHER RURAL CRITICAL ACCESS HOSPITALS ON WAYS THEY HAVE MET THEIR COMMUNITY'S MENTAL HEALTH NEEDS; II) CONTACT AREA MENTAL HEALTH PROVIDERS TO FIND OUT WHETHER THEY BELIEVE JCHC COULD HELP TO MEET THE COMMUNITY NEEDS; III) POSSIBLE OPTIONS: COULD WE OFFER TELEHEALTH CONNECTIONS BRINGING PATIENTS AND PROVIDERS TOGETHER? COULD WE OFFER A SPECIALTY CLINIC OFFERING MENTAL HEALTH ASSISTANCE?THERE WERE NEEDS IDENTIFIED THAT JCHC DID NOT ADDRESS. WHILE THESE NEEDS ARE IMPORTANT TO THE COMMUNITY, THEY WERE NOT CHOSEN BASED ON THE PRIORITIZATION PROCESS. THESE NEEDS INCLUDE: ALZHEIMER'S DISEASE, UNINTENTIONAL INJURIES, HEALTH CARE PROVIDER COVERAGE WHEN EXISTING PHYSICIANS RETIRE, FUTURE OF HEALTH CARE, WEAKENING FAMILY STRUCTURE/PARENTING, LACK OF DOCTORS/HEALTH CARE, DRUG/ALCOHOL USE AND THE AGING POPULATION. JEFFERSON COMMUNITY HEALTH CENTER, INC. PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED TO ANY INDIVIDUAL FOR EMERGENCY AND ALL OTHER MEDICALLY NECESSARY CARE WILL BE BASED ON AMOUNTS GENERALLY BILLED (AGB) TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE AT JCHC. AN ADDITIONAL DISCOUNT OPPORTUNITY FOR PROMPT PAYMENT IS AVAILABLE TO SELF-PAY PATIENTS. JCHC WILL DETERMINE ITS AGB BY DETERMINING AN AGB PERCENTAGE AND MULTIPLYING THAT PERCENTAGE BY THE GROSS CHARGES FOR THE SERVICES PROVIDED TO THE INDIVIDUAL. JCHC WILL UTILIZE THE LOOK-BACK METHOD AS DESCRIBED IN 1.501(R)-5(B) TO DETERMINE AGB. JCHC DETERMINES AGB BASED ON ALL MEDICARE, MEDICAID AND PRIVATE INSURANCE CLAIMS PAID IN FULL TO JCHC OVER A 12-MONTH PERIOD, DIVIDED BY THE ASSOCIATED GROSS CHARGES FOR THOSE CLAIMS. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY JEFFERSON COMMUNITY HEALTH CENTER, INC. PART V, SECTION B, LINE 16A WEBSITE: HTTP://JCHC.US JEFFERSON COMMUNITY HEALTH CENTER, INC. PART V, SECTION B, LINE 16B WEBSITE: HTTP://JCHC.US JEFFERSON COMMUNITY HEALTH CENTER, INC. PART V, SECTION B, LINE 16C WEBSITE: HTTP://JCHC.US 1 GARDENSIDE 200 H STREET FAIRBURY NE 68352 LONG TERM CARE FACILITY PART I, LINE 3C: FEDERAL POVERTY GUIDELINES ARE USED TO DETERMINE ELIGIBILITY FOR PROVIDING FREE AND DISCOUNTED CARE TO LOW INCOME INDIVIDUALS. PART I, LINE 6A: JEFFERSON COMMUNITY HEALTH CENTER PREPARES ITS OWN COMMUNITY BENEFIT REPORT. PART I, LINE 7: THE HOSPITAL USED THE WORKSHEETS PROVIDED IN THE FORM 990 INSTRUCTIONS TO HELP CALCULATE THE FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST. PART I, LINE 7G: THERE ARE NO COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC INCLUDED ON LINE 7G. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A) BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $458,902. PART I, LINE 7: JCHC REACHED OUT TO THE COMMUNITY IN A VARIETY OF WAYS IN FISCAL YEAR 2015, INCLUDING:I. BENEFITS FOR THE POOR/PUBLIC PROGRAMS A. TRADITIONAL CHARITY CARE: JCHC PROVIDED CHARITY CARE IN FISCAL 2015 TO THOSE WHO MEET THE FEDERAL POVERTY GUIDELINES. THE BUSINESS OFFICE STAFF MEMBERS FILE INSURANCE CLAIMS FOR PATIENTS.PATIENTS ASSISTED: 125. VALUE: $132,000. B. UNPAID COSTS OF PUBLIC PROGRAMS: MEDICAID SHORTFALL - SHORTFALL BASED ON COSTS: $0 C. BAD DEBT: BESIDES OFFICIAL CHARITY CARE, JCHC WROTE OFF $458,902 IN BAD DEBT DURING FISCAL 2015. II. COMMUNITY BENEFIT SERVICESA. COMMUNITY HEALTH EDUCATION AND OUTREACH: CHILD SAFETY SEAT PROGRAM- JCHC IS A PART OF A CHILD SAFETY SEAT COALITION AND HOLDS CHILD SAFETY SEAT CHECKUP EVENTS DURING THE YEAR, AS WELL AS OFFERING INDIVIDUAL INSTRUCTION IN PROPER USE OF SEATS. A TOTAL OF 76 SEATS WERE CHECKED IN CHECK-UP EVENTS AND IN INDIVIDUAL APPOINTMENTS. GRANTS ARE RECEIVED TO PURCHASE SEATS TO HAVE AVAILABLE, BUT STAFF TIME IS DONATED BY JEFFERSON COMMUNITY HEALTH CENTER. ESTIMATED VALUE OF STAFF TIME: $1,050.HEALTH FAIR- JCHC PROVIDES EDUCATIONAL BOOTHS, FREE HEALTH SCREENINGS, HANDOUTS, INFORMATION, ETC., AT THE JEFFERSON COUNTY SPRING EXPO AND THE JEFFERSON COUNTY FAIR. AN ESTIMATED 450+ TOOK PART IN OFFERINGS FROM JCHC AT THESE EVENTS. FOR 2015, THE COSTS OF BOOTHS, GIVEAWAYS, STAFF TIME, ETC., ARE ESTIMATED AT $2,500. ESTIMATED NUMBER REACHED: 450.SPEAKERS' BUREAU- JCHC STAFF MEMBERS PROVIDE EDUCATIONAL PROGRAMS FOR COMMUNITY ORGANIZATIONS ON A VARIETY OF TOPICS. A TOTAL OF 25 PROGRAMS WERE DONE IN FISCAL 2015. TOTAL INDIVIDUALS REACHED: 1,100. ESTIMATED COST OF STAFF TIME: $900.SUPPORT GROUPS - IN 2015, JCHC COORDINATED A PARKINSON'S SUPPORT GROUP AND ALZHEIMER'S CAREGIVER'S SUPPORT GROUP. JCHC STAFF MEMBERS COORDINATED MEETINGS OF THESE SUPPORT GROUPS, OFFERING ASSISTANCE TO ANYONE INTERESTED IN MORE INFORMATION ABOUT THE DISEASES. THE PARKINSON'S SUPPORT GROUP MEETS MONTHLY. TOTAL ATTENDANCE DURING FISCAL 2015 WAS 57. A SUPPORT GROUP FOR CAREGIVER'S OF ALZHEIMER'S PATIENTS MEETS MONTHLY AND HAD ATTENDANCE OF 51 THROUGHOUT THE YEAR. JCHC PROVIDES EDUCATIONAL PROGRAMS FOR EACH OF THESE GROUPS -- INCLUDING SPEAKER'S FEES OR VIDEO TAPE RENTAL FEES, POSTAGE TO SEND OUT MEETING NOTICES, AND REFRESHMENTS. TOTAL NUMBER REACHED: 108. APPROXIMATE COST OF STAFF TIME SPENT: $1,000. ESTIMATED COST OF POSTAGE: $325. ESTIMATED OTHER COSTS (MATERIALS, SPEAKER FEES): $100. HEALTH PROMOTION PROGRAMS- JCHC OFFERS SMOKING CESSATION INFORMATION TO PATIENTS AND THE PUBLIC. EACH INPATIENT WHO IS A SMOKER IS PROVIDED INFORMATION ON SMOKING CESSATION. ESTIMATED NUMBER REACHED: 94; ESTIMATED COST OF PROMOTIONAL MATERIALS PROVIDED: $480.34. B. COMMUNITY-BASED CLINICAL SERVICES (SCREENINGS AND ONE-TIME OR OCCASIONALLY HELD CLINICS): COMPLETE BLOOD PROFILES - COMPLETE BLOOD PROFILES WERE OFFERED IN THE SPRING AT A REDUCED RATE. A TOTAL OF 82 BLOOD PROFILES WERE OFFERED. PARTICIPANTS PAID $45, WHICH IS A FRACTION OF THE ESTIMATED VALUE OF THE TESTING. ESTIMATED STAFF TIME: $1,200. IMMUNIZATION CLINICS- JCHC COOPERATES WITH BLUE VALLEY COMMUNITY ACTION IN PROVIDING IMMUNIZATION CLINIC FOR CHILDREN TWICE EACH MONTH. JCHC PROVIDES SPACE WHERE IMMUNIZATIONS ARE DONE, NURSING STAFF, THE PATIENT WAITING AREAS, JANITORIAL AND SUPPORT SERVICES, AND STORAGE OF VACCINES IN OUR PHARMACY. NUMBER OF CHILDREN SERVED: 414. TOTAL OF 1,361 VACCINATIONS PROVIDED. ESTIMATED COST OF NURSES PROVIDED BY JCHC TO GIVE SHOTS: $1,620. C. HEALTH CARE SUPPORT SERVICES:ENROLLMENT ASSISTANCE IN PUBLIC PROGRAMS - JCHC OFFERED A COMMUNITY EDUCATION PROGRAM ON MEDICARE PART D DRUG PROGRAM PROVIDED BY JCHC EMPLOYEES TRAINED AS SCHIIP VOLUNTEERS (200), AND PRENATAL CLASSES (10). ESTIMATED NUMBER OF PEOPLE REACHED: 220. ESTIMATED COST OF PROGRAMS, FOOD, AND STAFF TIME: $4,000. III. MEDICAL EDUCATION A. SCHOLARSHIP FUNDING FOR HEALTH PROFESSIONS: PHYSICIAN/MEDICAL STUDENTS, NURSES/NURSING STUDENTS, TECHNICIANS AND OTHER HEALTH PROFESSIONALS. JCHC WORKS WITH SOUTHEAST COMMUNITY COLLEGE IN BEATRICE AS A SITE FOR LPN PRACTICAL NURSING TRAINING. AN ESTIMATED 60 STUDENTS LEARNED IN OUR FACILITY IN 2015. NURSING STUDENTS UTILIZE MEETING ROOM SPACE AT JCHC, AS WELL AS TAKE PART IN CLINICAL PRACTICE. IN FISCAL 2015, ONE PHARMACY STUDENT ALSO DID A ROTATION AT JEFFERSON COMMUNITY HEALTH CENTER AS A PART OF THE EDUCATIONAL EXPERIENCE. MEDICAL STUDENTS COME REGULARLY FOR RURAL ROTATIONS TO LEARN FROM LOCAL PHYSICIANS. JCHC PROVIDES AN APARTMENT FOR THE MEDICAL STUDENTS TO STAY IN DURING THEIR TIME IN FAIRBURY, AND ALSO PROVIDES THEM USE OF OUR WELLNESS CENTER DURING THEIR STAY. FOUR MEDICAL STUDENTS UTILIZED OUR FACILITY IN 2015. JCHC OFFERS THE LILLIAN HANSEN REESMAN RN MEMORIAL NURSES SCHOLARSHIP FUND. SCHOLARSHIPS ARE OFFERED FROM THIS FUND, ESTABLISHED IN 1980. ONLY INTEREST IS USED FROM THIS $10,000 PERPETUAL FUND, DONATED BY THE REESMAN FAMILY, TO PROVIDE NURSING SCHOLARSHIPS. SCHOLARSHIPS ARE PROVIDED AS INTEREST FUNDS ARE AVAILABLE. ONE $500 SCHOLARSHIP WAS AWARDED IN FISCAL 2015. THE JCHC AUXILIARY PROVIDES A SCHOLARSHIP FOR STUDENTS PURSUING AN EDUCATION IN MEDICAL FIELDS. THE $400 SCHOLARSHIP IS GIVEN FROM THE AUXILIARY'S FUNDS, AND THE NUMBER OF SCHOLARSHIPS GIVEN EACH YEAR IS BASED ON THE AUXILIARY'S FUNDING AVAILABILITY AND THE NUMBER OF REQUESTS. ONE SCHOLARSHIP WAS AWARDED IN 2015. ESTIMATED NUMBER REACHED: 66. JCHC COST (APARTMENT RENT, STAFF TIME, ETC.): $4,600. B. OTHER: JOB SHADOWING- JCHC HOSTS JOB SHADOW STUDENTS THROUGH FAIRBURY HIGH SCHOOL'S ANATOMY AND PHYSIOLOGY CLASS, THROUGH THE SOUTHEAST COMMUNITY COLLEGE-FAIRBURY HIGH SCHOOL CAREER ACADEMY PROGRAM, AND FOR INTERESTED INDIVIDUALS. THIS YEAR, SHADOWING OPPORTUNITIES WERE ALSO ARRANGED FOR STUDENTS AS A PART OF THE SCC CAREER ACADEMY, AND OTHER INDIVIDUALS WHO WERE INTERESTED. A TOTAL OF 31 STUDENTS PARTICIPATED IN SHADOWING OPPORTUNITIES IN FISCAL 2015. NUMBER REACHED: 31. ESTIMATED COST OF STAFF TIME: $2,650.VIDEOCONFERENCE- CONTINUED OFFERING VIDEOCONFERENCING CAPABILITIES, INCLUDING POSSIBLE PROGRAMS FOR PROFESSIONALS IN THE COMMUNITY. AVAILABILITY COSTS $100 PER MONTH. A TOTAL OF 56 EDUCATIONAL AND ADMINISTRATIVE PROGRAMS WERE OFFERED IN 2014. THIS INCLUDED A NUMBER OF OPPORTUNITIES FOR STAFF AND COMMUNITY EDUCATION, MEETINGS, AND CLINICAL VISITS. ESTIMATED NUMBER REACHED: 80. COST FOR 2014: $1,200.IV. SUBSIDIZED HEALTH SERVICESA. WELLNESS CENTER SUPPORT:JEFFERSON COMMUNITY HEALTH CENTER HAS OPERATED THE BOB AND WAUNETA BURKLEY WELLNESS CENTER AS A COMMUNITY WELLNESS CENTER SINCE IT OPENED IN 1996. JCHC PAYS THE WELLNESS CENTER'S OPERATING EXPENSES THAT EXCEED REVENUES. BECAUSE OF THE HEALTH CENTER'S SUPPORT OF THE WELLNESS CENTER'S CASH FLOW, PRICES FOR MEMBERSHIPS AND SERVICES CAN REMAIN REASONABLE FOR COMMUNITY RESIDENTS. IF THE WELLNESS CENTER WERE A STAND-ALONE OPERATION, PRICES WOULD HAVE TO RISE CONSIDERABLY TO PAY ALL EXPENSES. NUMBER OF PERSONS SERVED: 1,153 (MEMBERS AS OF FISCAL YEAR-END 2015.) ESTIMATED AMOUNT OF WELLNESS CENTER SUPPORT: $247,171. V. RESEARCH. NO RESEARCH DOLLARS EXPENDED.VI. CASH AND IN-KIND DONATIONSA. CASH DONATIONS: JCHC MAKES DONATIONS TO VARIOUS CHARITABLE CAUSES, INCLUDING GIRL SCOUT AND BOY SCOUT FIRST AID KITS, FREE LOAN OF HOME BILIRUBIN BLANKET, SPONSORSHIP OF BASEBALL AND SOFTBALL TEAMS, GOLF TOURNAMENTS, AREA HIGH SCHOOL POST PROM ACTIVITIES, AN AREA COMMUNITY PICNIC, A LOCAL DANCE RECITAL, AN AREA RODEO, CHAMBER OF COMMERCE BANQUET, CHAMBER OF COMMERCE NEW TEACHER WELCOME, CHAMBER OF COMMERCE TEACHER RECOGNITION, LOANING OUT CPR MANNEQUINS, ETC. THESE TOTALED $924.70. JCHC ALSO CONTRIBUTES ITEMS -- SUCH AS WELLNESS CENTER PASSES, JCHC GLASSES AND DUFFLE BAGS, ETC., TO COMMUNITY EVENTS AS DOOR PRIZES. THESE TOTALED AN ESTIMATED $450. USE OF A BILIRUBIN BLANKET WAS DONATED FOR NEWBORNS WITH JAUNDICE FOR 3 FAMILIES FOR 30 DAYS OF IN-KIND USE, FOR A VALUE OF $3,300. DONATIONS DURING FISCAL 2015 TOTALED $4,674.70. B. IN-KIND DONATIONS: WALK TO END ALZHEIMER'S - JEFFERSON COMMUNITY HEALTH CENTER SUPPORTS THE ANNUAL WALK TO END ALZHEIMER'S BY PROVIDING STAFF TIME AND POSTAGE TO SEND OUT SPONSORSHIP LETTERS AND NEWS RELEASES PROMOTING THE EVENT, STAFF TIME TO ASSIST IN PLANNING THE EVENT, AND STAFF TIME THE DAY OF THE EVENT. A TOTAL OF 19 WALKERS PARTICIPATED AND THE EVENT RAISED $3,920 FOR THE ALZHEIMER'S ASSOCIATION. ESTIMATED POSTAGE: $22. ESTIMATED STAFF TIME: $240. PART I, LINE 7 (CONTINUED): SAFE KIDS CHAPTER- JEFFERSON COMMUNITY HEALTH CENTER IS A MEMBER OF THE SAFE KIDS COALITION. THREE JCHC STAFF MEMBERS PARTICIPATE IN THE ORGANIZATION. THEY ARE JOINED BY A VARIETY OF OUTSIDE AGENCIES IN THE COMMUNITY WHO BELIEVE STRONGLY IN CHILDHOOD SAFETY. IN ADDITION TO SAFETY SEAT CHECKUP EVENTS, OTHER SAFETY PROMOTIONS WERE OFFERED. ESTIMATED STAFF TIME: $1,200. BLOOD DRIVE SUPPORT- JCHC ASSISTS NEBRASKA COMMUNITY BLOOD BANK BY SCHEDULING APPOINTMENTS FOR SIX BLOOD DRIVES EACH YEAR. THE BLOOD PRODUCTS ULTIMATELY HELP OUR COMMUNITY, AS NEBRASKA COMMUNITY BLOOD BANK IS JCHC'S SUPPLIER OF BLOOD AND BLOOD PRODUCTS. ESTIMATED STAFF TIME: $250.SAFETY DAY FOR KIDS- JCHC WAS ONE OF THE CO-SPONSORS FOR THE ANNUAL SAFETY DAY FOR KIDS IN JEFFERSON COUNTY. A TOTAL OF 84 KIDS -- AGES KINDERGARTEN THROUGH SIXTH GRADES -- ATTENDED. STAFF MEMBERS ASSISTED IN PLANNING THE EVENT AND ASSISTED IN COORDINATING AND INSTRUCTING ON THE DAY OF THE CAMP. THE COST OF STAFF TIME DONATED IS ESTIMATED AT: $1,150. TOTAL COST OF SUPPLIES FURNISHED WAS $250. GO RED FOR WOMEN- JCHC STAFF ORGANIZED THE FIRST GO RED FOR WOMEN FUND-RAISING EVENT FOR THE AMERICAN CANCER SOCIETY IN 2015. THE EVENT RAISED $3,675 FOR THE AMERICAN CANCER SOCIETY. COST OF STAFF TIME DONATED IS ESTIMATED AT: $500. NUMBER ATTENDING EVENT: 52 RELAY FOR LIFE- JCHC, GARDENSIDE AND CEDARWOOD HAVE A RELAY FOR LIFE TEAM. IN 2015, THIS TEAM RAISED $2,500 FOR THE AMERICAN CANCER SOCIETY. COST OF STAFF TIME DONATED IS ESTIMATED AT: $6,000. ESTIMATED NUMBER ATTENDING EVENT: 250 PART II, COMMUNITY BUILDING ACTIVITIES: JEFFERSON COMMUNITY HEALTH CENTER IS ACTIVE IN LOCAL ECONOMIC DEVELOPMENT ACTIVITIES. JCHC IS A MEMBER OF THE FAIRBURY CHAMBER OF COMMERCE. JCHC SEEKS OPPORTUNITIES TO OFFER TOURS, HEALTH CARE INFORMATION ON COMMUNITY WEBSITES, ETC. IN ADDITION TO THESE DIRECT PROGRAMS AND SERVICES, THE EMPLOYEES OF JEFFERSON COMMUNITY HEALTH CENTER SERVE THEIR COMMUNITY IN MANY WAYS INCLUDING SERVING IN THEIR CHURCHES AS GIRL AND BOY SCOUT LEADERS, AS 4-H LEADERS, AS LEADERS IN CIVIC ORGANIZATIONS, AS YOUTH GROUP LEADERS, AS CITY GOVERNMENT MEMBERS, ON COMMUNITY DEVELOPMENT BOARDS, FOR EMERGENCY RESPONSE ORGANIZATIONS AND OTHERS. JCHC STAFF MEMBERS ARE A RESOURCE AS COMMUNITY ROLE MODELS.JCHC IS PROUD OF ITS CONTRIBUTIONS TO THE CITIZENS OF JEFFERSON COUNTY AND THE SURROUNDING AREA. THE CITIZENS OF THIS AREA ALSO HIGHLY REGARD JCHC'S CONTRIBUTIONS TO THE COMMUNITY.THE GOAL OF THE JCHC BOARD OF DIRECTORS, ADMINISTRATION AND STAFF IS TO EXPAND THAT PARTNERSHIP WITH AREA RESIDENTS AND FIND MORE WAYS TO SERVE AS A RESOURCE FOR HEALTH AND WELLNESS INFORMATION. PART III, LINE 3: AS PART OUR COMMUNITY NEEDS ASSESSMENT, WE GATHERED INFORMATION ON THE INCOME CHARACTERISTICS OF THE UNINSURED POPULATION. USING THAT DATA, WE ANALYZED WHAT PORTION OF UNINSURED INDIVIDUALS IN THE HOSPITAL'S SERVICE AREA WOULD BE ELIGIBLE FOR THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. THIS PERCENTAGE WAS APPLIED TO THE TOTAL AMOUNT OF BAD DEBT FOR SELF-PAY PATIENTS TO ESTIMATE THE PORTION OF SELF-PAY BAD DEBT THAT WAS LIKELY ATTRIBUTABLE TO INDIVIDUALS ELIGIBLE FOR THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. PART III, LINE 4: JCHC'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT EXPENSE. HOWEVER, PAGES 7 AND 8 OF THE ATTACHED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "PATIENT RECEIVABLES, NET," "NET PATIENT SERVICE REVENUE AND "CHARITY CARE". PART III, LINE 8: THE HOSPITAL CALCULATED THE MEDICARE ALLOWABLE COSTS BY ADDING THE INPATIENT, SWING BED AND OUTPATIENT COSTS AS FOUND ON THE MEDICARE COST REPORT FOR SEPTEMBER 30, 2015. NO SHORTFALL IS TREATED AS COMMUNITY BENEFIT. PART III, LINE 9B: ONCE IT IS DETERMINED THAT A PATIENT MAY NOT HAVE THE MEANS TO PAY, AN ASSISTANCE APPLICATION IS PROVIDED. IN ADDITION, ALL ACCOUNTS THAT OUR SELF-PAY RECEIVABLE VENDOR DID NOT RECEIVE PAYMENT ON AFTER 75 DAYS WILL BE RUN THROUGH A PRESUMPTIVE CHARITY CRITERIA PROCESS. THIS PROCESS ASSISTS IN THE DETERMINATION OF FINANCIAL ASSISTANCE ELIGIBILITY. JCHC STAFF WILL APPLY THE RECOMMENDED PERCENTAGE DISCOUNT TO THE PATIENT'S ACCOUNT. PART VI, LINE 2: JCHC ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY JCHC SERVES IN SEVERAL WAYS. JCHC UTILIZES SURVEYS BY PUBLIC HEALTH SOLUTIONS OF THE HEALTH CARE NEEDS FOR RESIDENTS OF JEFFERSON COUNTY AND THE SURROUNDING COMMUNITY. JCHC VISITS LOCAL COMMUNITY SERVICE ORGANIZATIONS AND SEEKS INPUT ON NEEDS. JCHC CONDUCTED A COMMUNITY PERCEPTION SURVEY IN 2006, WHICH INCLUDES QUESTIONS ON COMMUNITY HEALTH NEEDS. JCHC REVIEWS SURVEYS DONE BY THE STATE AND OTHER ORGANIZATIONS ON THE HEALTH CARE NEEDS FOR RESIDENTS OF JEFFERSON COUNTY AND THE SURROUNDING AREA. PART VI, LINE 3: JCHC INFORMS AND EDUCATES PATIENTS ABOUT ELIGIBILITY FOR ASSISTANCE ON AN INDIVIDUAL BASIS WHEN QUESTIONS ARISE. THE PATIENT BOOKLET PROVIDES BUSINESS OFFICE CONTACT INFORMATION FOR PATIENT QUESTIONS ABOUT THEIR BILL. THE SELF-PAY BILLING VENDOR ENGAGED BY JCHC HAS A SET OF CRITERIA IT USES TO ASSESS WHETHER A PATIENT IS ELIGIBLE FOR ASSISTANCE PROGRAMS, OR IF THEY QUALIFY FOR JCHC'S CHARITY CARE PROGRAM. PART VI, LINE 4: JCHC SERVES JEFFERSON COUNTY AND PARTS OF THAYER, FILLMORE, SALINE AND GAGE COUNTIES, ALL IN NEBRASKA; AND PARTS OF WASHINGTON AND MARSHALL COUNTIES IN KANSAS. THE POPULATION OF THE SERVICE AREA IS ESTIMATED AT ABOUT 18,000. REVENUE FROM MEDICARE PATIENTS AVERAGES APPROXIMATELY 50%, AND REVENUE FROM MEDICAID CLIENTS AVERAGES APPROXIMATELY 10%. PART VI, LINE 5: JCHC OPERATES IN JEFFERSON COUNTY WITH A COMMUNITY BOARD AND OPEN MEDICAL STAFF. ALL SURPLUS FUNDS ARE REINVESTED BACK INTO THE FACILITY THROUGH BUILDING CONSTRUCTION, EQUIPMENT PURCHASES, OR COMMUNITY PROGRAMS PROVIDED. JCHC PROMOTES THE HEALTH OF THE COMMUNITY BY OFFERING A COMMUNITY WELLNESS CENTER AT A REASONABLE RATE AND OFFERING SCHOLARSHIPS FOR THE COMMUNITY'S YOUTH WHO HAVE FINANCIAL NEED. THE NET COMMUNITY BENEFIT REPORTED IN PART I RELATING TO THE WELLNESS CENTER WAS $237,000. JCHC PROMOTES THE HEALTH OF THE COMMUNITY BY PROMOTING COMMUNITY-WIDE PROGRAMS SUCH AS LIVE HEALTHY NEBRASKA AND STEP-2-IT (PROGRAMS WHICH ENCOURAGE INCREASING ACTIVITY AND LOSING WEIGHT.) JCHC IS ALSO INVOLVED IN CAR SAFETY SEAT CHECKS, PROGRESSIVE AG SAFETY DAY, AND WORKING WITH BLUE VALLEY COMMUNITY ACTION TO OFFER IMMUNIZATIONS TO AREA CHILDREN. JCHC PROMOTES THE HEALTH OF THE COMMUNITY BY OFFERING PROGRAMS, TOURS, SPEAKERS, AND EDUCATION, INCLUDING SUPPORT GROUPS, EDUCATIONAL PROGRAMS AND PROGRAMS FOR LOCAL ORGANIZATIONS. PART VI, LINE 6: JCHC IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM BUT DOES WORK TO BE A LEADER IN PROMOTING THE HEALTH OF THE COMMUNITIES IT SERVES. JCHC PARTNERS WITH MANY OTHER AREA ORGANIZATIONS, INCLUDING PUBLIC HEALTH SOLUTIONS, FARM SAFETY 4 JUST KIDS, NEBRASKA SAFE KIDS, JEFFERSON COUNTY EXTENSION, BLUE VALLEY COMMUNITY ACTION, FAIRBURY CHAMBER OF COMMERCE, FAIRBURY PUBLIC SCHOOLS, FAIRBURY CLINIC, NEBRASKA COMMUNITY BLOOD BANK, RURAL COMPREHENSIVE CARE NETWORK, BLUE RIVER VALLEY NETWORK, HEARTLAND HEALTH ALLIANCE, AND OTHERS. DEPENDING ON THE ACTIVITY, JCHC MAY BE THE LEAD ORGANIZATION, OR AN ORGANIZATION PROVIDING HELP AND ASSISTANCE. PART VI, LINE 7: JCHC DOES NOT FILE A COMMUNITY BENEFIT REPORT WITH ANY STATES. X 0 0 X X X X 0 0 0 0 0 0 0 0 0 CHAD JURGENS CEO 152128 0 0 0 37 0 8074 0 13946 0 174185 0 0 0 GARY MITCHELL DIRECTOR OF PHARMACY 138402 0 0 0 24 0 7512 0 13946 0 159884 0 0 0 PART I, LINE 1A JCHC PROVIDES DISCOUNTED OR FREE WELLNESS CENTER MEMBERSHIPS TO ITS EMPLOYEES AND PHYSICIANS. A HOSPITAL AUTHORITY NO 1 OF JEFFERSON COUNTY NE 611683496 2012-12-18 5800000 CONSTRUCTION AND RENOVATION OF FACILITIES 0 0 0 A 189703 5800000 50001 5749999 2015 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 1 0 0 0 0 0 0 1 A 1 MARY HOPPE EMPLOYEE OF THE HOSPITAL AND SPOUSE OF DICK HOPPE, CHAIRMAN OF THE BOARD 86528 EMPLOYEE COMPENSATION 0 CAROL BLOBAUM EMPLOYEE OF THE HOSPITAL AND SPOUSE OF BRIAN BLOBAUM, BOARD MEMBER 76840 EMPLOYEE COMPENSATION 0 JACQUELINE WESCH EMPLOYEE OF THE HOSPITAL AND SPOUSE OF JACK WESCH, BOARD MEMBER 29370 EMPLOYEE COMPENSATION 0 FAIRBURY CLINIC PC DR. TED TUCKER, BOARD MEMBER, OWNS MORE THAN 5% OF FAIRBURY CLINIC P.C. 603198 FAIRBURY CLINIC P.C. PROVIDED EMERGENCY ROOM COVERAGE SERVICES TO JEFFERSON COMMUNITY HEALTH CENTER. 0 FORM 990, PART VI, SECTION A, LINE 6 JEFFERSON COMMUNITY HEALTH CENTER HAS MEMBERS. ANY PERSON, CORPORATION OR OTHER ENTITY MAY BECOME A LIFETIME MEMBER IF A CONTRIBUTION OF $100 OR MORE IS MADE TO THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A VACANCIES, OCCURRING ON THE BOARD BY EXPIRATION, SHALL BE FILLED THROUGH ELECTION BY THE MEMBERS AT THE ANNUAL MEETING OF THE MEMBERS. THE BOARD DEVELOPMENT COMMITTEE SHALL SUBMIT A SLATE OF PROSPECTIVE CANDIDATES TO THE BOARD OF DIRECTORS AT THEIR MEETING PRIOR TO THE ANNUAL MEETING WHICH WILL THEN BE PRESENTED AT THE ANNUAL MEETING FOR CONSIDERATION FOR ELECTION TO THE BOARD. IN ADDITION, MEMBERS OF THE CORPORATION MAY MAKE NOMINATIONS FROM THE FLOOR. FORM 990, PART VI, SECTION A, LINE 7B EACH MEMBER SHALL BE ENTITLED TO ONE VOTE ON EACH MATTER SUBMITTED TO THE VOTE OF THE MEMBERS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED BY THE CFO PRIOR TO SUBMISSION TO THE IRS AND BY THE BOARD MEMBERS AT A REGULAR BOARD MEETING FOLLOWING SUBMISSION TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED, BY THE ARTICLES AND BYLAWS, TO REVIEW THE CONFLICT OF INTEREST POLICY ANNUALLY. A BOARD MEMBER WITH A CONFLICT OF INTEREST IS REQUIRED TO ABSTAIN FROM VOTING ON ANY MOTION FOR WHICH HE HAS A CONFLICT OF INTEREST. BOARD MEMBERS ARE WELL ACQUAINTED WITH EACH OTHER AND WOULD BE AWARE OF ANY PERSONAL CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 THE HOSPITAL PARTICIPATES IN THE NEBRASKA COMPDATA SALARY SURVEYS FOR ALL POSITIONS. THE CEO SURVEY DATA IS GIVEN TO THE BOARD TO REVIEW, AND THE BOARD APPROVES THE CEO'S SALARY ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,756,478. MANAGEMENT AND GENERAL EXPENSES 153,291. FUNDRAISING EXPENSES 281. TOTAL EXPENSES 1,910,050. FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 33,751. MANAGEMENT AND GENERAL EXPENSES 19,792. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 53,543. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 46,398. MANAGEMENT AND GENERAL EXPENSES 3,745. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 50,143. CONSULTING: PROGRAM SERVICE EXPENSES 377. MANAGEMENT AND GENERAL EXPENSES 3,943. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,320. FORM 990, PAGE 11, PART XI, LINE 2C: THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS SELECTS THE INDEPENDENT ACCOUNTANT AND HAS THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT. UPON CONCLUSION OF THE AUDIT, THE AUDITING FIRM PRESENTS THE RESULTS AND FINDINGS TO THE FINANCE COMMITTEE. THERE HAVE BEEN NO CHANGES TO THIS PROCESS FROM THE PRIOR YEAR.